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The Donabedian Model is a conceptual model that provides a framework for examining health services and evaluating quality of care. According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes." Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refers to the effects of healthcare on the health status of patients and populations.[Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. While there are other quality of care frameworks, including the World Health Organization (WHO)-Recommended Quality of Care Framework and the Bamako Initiative, the Donabedian Model continues to be the dominant paradigm for assessing the quality of health care.

Avedis Donabedian received the degree of BA in 1940 and MD in 1944 and subsequently worked at the English Mission Hospital in Jerusalem, making a brief trip to England. As local war broke out over the partition of Palestine in 1948, he moved to the American University of Beirut where he occupied a number of teaching positions and became medical officer to the whole university. He became aware of his limitations as an administrator and developed a growing interest in the quality of health provision and in public health. An opportunity arose to study epidemiology and health services administration at Harvard, where he received his MPH degree (magna cum laude) in 1955. Not wishing to return to Lebanon due to political unrest, he received sponsorship to stay in the USA with his wife and children. He became a non-clinical teacher and researcher at New York Medical College from 1957 to 1961, when he was recruited by the School of Public Health at the University of Michigan. He spent the rest of his professional life there, becoming Nathan Sinai Distinguished Professor of Public Health in 1979, and continuing to work as emeritus professor until his death, in Ann Arbor, Michigan, USA, in 2000.

Donabedian collated the growing literature of health services research as it appeared through the 1950s and early 1960s and presented his findings in a lengthy paper in 1966 with the title “Evaluating the Quality of Medical Care”. This summation and analysis brought him immediate fame and is still widely cited and read: it was reprinted by The Milbank Quarterly in 2005. In it he sets out the necessity of examining the quality of health provision in the aspects of structure, process and outcome.

Much of his subsequent work was a detailed exposition of the concepts and methods required to examine these fundamental aspects of health care. He was an early exponent of systems management in health services. He strove to define every aspect of quality in health systems and proposed models for its measurement in over 100 papers and 11 books. These include access to health care, completeness and accuracy in medical records, observer bias, patient satisfaction, and cultural preferences in health care. The summation of his efforts is found in his trilogy, Explorations in quality assessment and monitoring (1980–85), a massive work of personal scholarship and analytical thought brought to bear on every aspect of health care provision. Here he suggests seven pillars of quality: efficacy, efficiency, optimality, acceptability, legitimacy, equity, and cost.

(Wikipedia: Donabedian)

Donabedian Model

Arvis Donabedian